Patients Provide Pleasant Surprises for Hospital Designers

AAMC Reporter: March 2011

—By Kelly Mahon, special to the Reporter

For the better part of three years, Carole Seigel watched her husband battle pancreatic cancer. When he finally succumbed to the disease, she thanked the doctors at Massachusetts General Hospital (MGH) for their care and compassion. At the same time, however, she felt compelled to offer some advice on an area she said needed improvement: the room itself.

Seigel put her own experience to work for MGH, joining the hospital cancer center’s patient and family advisory council, where she works to this day to enhance the design of hospital facilities for future patients.

In the wake of the Affordable Care Act (ACA) and other parallel movements, physicians and hospitals are striving to provide more patient-centered care. Programs like the medical home, which is intended to offer more centralized and coordinated treatment, are being tested across the country and seem to hold the potential to improve outcomes while controlling costs. But the redesign of the health care system does not always end with the care itself, and can encompass the design of actual facilities. Perhaps that is why, now more than ever before, patients and advocates like Carole Seigel literally help design hospitals from the ground up, often joining CEOs, architects, and physicians around the boardroom table from the moment blueprints are first dreamed up.

Their suggestions can be surprising at times, almost disruptively so. But that, of course, is the whole point.

“There are so many more creative ideas when patients and families are involved in the very beginning of the planning process,” said Hal Jones, director of the Office of Care Transformation at Emory Hospitals.

In general, hospitals designed to be patient-centric seek to create a comfortable, convenient, homelike atmosphere through attention to the physical layout of the building. Private rooms, special lodging for family members, and amenities like in-room showers are classic patient-centered touches, but aspects such as art and color schemes also tend to factor in.

At MGH, Seigel, along with 15 other members of the hospital’s patient-family council, had a hand in planning the Yawkey Center for Outpatient Care, which opened in Boston in 2004.

One of Seigel’s ideas was included in Yawkey’s final design: the placement of benches in the corridors. Perhaps at first glance, it would seem like a minor addition. Seigel felt otherwise.

“My husband was a young man, and his independence was important to him,” she said. “If he could only walk 10 feet at a time, the corridors seemed endless. Now when I walk in, there are benches on the corridor. This makes me so gratified. I can see Mike taking a minute to enjoy the view.”

Patient-centered hospitals, however, mean more than comfort and aesthetics. Through the burgeoning field of evidence-based design, hospitals, architects, and facility managers are starting to acquire hard data on how a facility’s layout affects care outcomes. A 2003 analysis by the Center for Health Design showed that single-occupancy rooms, combined with strategic placement of sinks and air filters, reduced by 11 percent the rate of nosocomial infections at Bronson Methodist Hospital in Kalamazoo, Mich. A 2004 study in the American Journal of Critical Care revealed a 70 percent reduction in medication errors through the use of adaptable rooms that serve multiple purposes, which decreased the need for patient turnover at what was then known as Clarian Health Methodist Hospital in Indianapolis.

Though not a new practice—children’s hospitals have involved patients and families in facility design for the past two decades—it is a growing trend among other hospitals, according to Tom Fannin, senior principal of FKP Architects, a health care facilities firm that has designed several teaching hospitals and health systems.

“Because of the success stories, the level of transparency and inclusiveness, and the growing emphasis on evidence-based design, we see this increasing and becoming a significant tool in our approach,” Fannin said.

Planners cannot always anticipate patient and family wants or needs. For example, the original design of the Children’s Hospital of Pittsburgh (CHP) featured private showers in each room. But when parents saw a mock-up of the space, they were, to the surprise of facility planners, less than satisfied.

“I remember the families saying, ‘You don’t have enough room at the foot of the bed—I’ve been in a room for 90 days and I see how much room is needed for equipment and staff,’” said Eric Hess, CHP’s vice president of operations and project executive of its hospital design. “They told us to take the shower out and open up the foot of the bed. They said, ‘I’ll shower somewhere else. Give the clinicians the room they need to take care of my child.’”

Emory Healthcare received a similar surprise when administrators invited patients along to help them select hospital beds.

“The doctors were all standing around the bed looking at it from a clinical perspective, and I was thinking about how we would maintain it,” said David Pugh, associate administrator for Emory Hospitals. “Then, all of a sudden, one of the patients who came with us hopped in the bed. She was sitting there saying, ‘Oh, I can’t reach this control,’ and what have you. We were getting immediate feedback. It was one of those a-ha moments.”

Of course, building or retrofitting a hospital for any reason can be very expensive. At most medical schools and teaching hospitals, cost—along with a proposed facility’s fit with the institution’s strategic plan, space availability, and other factors—is a key part of the discussion. The American Hospital Association has reported that 67 percent of hospitals have not started or continued capital projects because of the 2008 recession.

“Obviously, in today’s fiscal climate, you have to be careful and thoughtful about what space you invest in,” said Mike Boyd, executive director of facilities planning, design, and construction at the University of California, Davis Health System. “In new construction or remodeling, every additional square foot is expensive to build, so it’s a matter of balancing both financial and nonfinancial considerations. Patient safety and operational efficiency tend to be the most important drivers during the design process, but in the end, we also want to create a healing environment that respects privacy and is very comfortable, beautiful, and enduring.”

With cost a major factor, it may be reassuring to learn that facilities can enhance the patient experience without building a new hospital. According to the Institute for Healthcare Improvement, existing facilities can use sound-deadening materials such as special ceiling tiles and more effective signage to improve noise control and better direct patients and families, respectively.

Studies show that sound absorbers can also improve speech intelligibility, add to patient satisfaction, and reduce staff stress.

Such modifications can be pricey, but new data show they can yield financial rewards. A 2008 study published in Healthcare Financial Management concluded that patient-centered facilities have significantly lower costs per case and lower staffing costs because the hospital is able to retain staff and rely more heavily on lower-cost ancillary staff.

A 2008 report by the Georgia Institute of Technology and the Center for Health Design suggested that a patient-centered institution can expect to recover building costs over time. Although the return on investment will vary, the report indicates that hospitals can gain revenue by reducing infections and the average length of stay, decreasing litigation, and improving the hospital’s bond rating.

This was true for Children’s Hospital of Pittsburgh, whose patient volumes have grown since the new facility opened its doors. Hospital leaders have reported a 3.1 percent increase in inpatient admissions, a 19 percent increase in emergency department patients, and an 8.5 percent increase in outpatient admissions.

MGH expects its patient satisfaction ratings to improve over time, especially when its Building for the Third Century opens this year. Carole Seigel and the cancer center’s patient-family advisory council were involved in the design of this building.

Emory University Orthopaedics and Spine Hospital, built with patient and family input, consistently receives a 99th percentile ranking in the patient satisfaction scores conducted by Press Ganey.

For Carole Seigel, patient and family involvement is part of the healing process.

“It speaks a great deal that the center was able to listen to all of us,” she said. “It shows we are more than blood levels and cells to them. It makes a real statement.”

The Association of American Medical Colleges is a not-for-profit association representing all 144 accredited U.S. and 17 accredited Canadian medical schools, nearly 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers, and nearly 90 academic and scientific societies.

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